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By G. Khabir. Tougaloo College.

These may be of interest: David: For many people perindopril 2mg line, Dr buy perindopril 2mg with mastercard. What is the best way for them to cope without "kissing" up to this person and being always vigilant about what you say and how you say it? Vaknin: It depends whether the narcissistic bully represents the corporate culture of the workplace - or is an isolated case attributable to a quirky nature or a personality disorder buy perindopril 2 mg line. Bullies rarely dare to express their tendencies in isolation and in defiance of the prevailing ethos. Or, if they do run against the grain of their place of employment, they lose their jobs. Typically, narcissists join already narcissistic firms and mesh well with a toxic workplace, a poisonous atmosphere, and an abusive management. If one is not willing to succumb to the mores and (lack of) ethics of the workplace, there is little one can do. Surprisingly few countries (Sweden, the United Kingdom, to some extent) outlaw workplace abuse specifically. Whistleblowers and "troublemakers" are frowned upon and are not protected by any institutions. The victim would do well to simply resign and move on, sad as this may be. As awareness of the phenomenon increases and laws take effect, hopefully this will change and bullied and abused workers will find effective ways to cope with mistreatment. TimeToFly: What typically happens to a narcissist when they lose their position of authority or their job. But since then he has been on a rampage to destroy me. It was right after the loss of his previous job that he left me and our children 4 years ago. He had been the manager of engineering and was first demoted, and then finally left the company. He has just remarried, but his new life somehow has not distracted him from his obsession with destroying mine. The entire edifice of the Narcissistic Personality Disorder is an elaborate and multi-layered reaction to past narcissistic injuries. A gap opens between the way the narcissistic imagines himself to be (grandiosity) and reality (unemployed, humiliated, discarded, unneeded). The narcissist strives to bridge the grandiosity gap but sometimes it is simply to abysmal to deny or ignore. So, some narcissists go through decompensation - their defense mechanisms crumble. The narcissists redouble their efforts to obtain narcissistic supply by any means - sex, exercise, attention-seeking behaviors. Yet others withdraw altogether to "lick their wounds" (schizoid posture). What is common to all these narcissists is the ominous feeling that they are losing control (and maybe even losing it). In a desparate effort to re-exert control, the narcissist becomes abusive. Others seek "easy targets" - lonely women to "conquer" or simple tasks to accomplish, or no-brainers, or to compete against weak opponents with a guaranteed result. The accepted wisdom is that NPD is tan adaptative reaction to early childhood or early adolescence trauma and abuse. The more familiar ones - verbal, emotional, psychological, physical, sexual - of course yield psychopathologies. But are far more subtle and more insidious forms of mistreatment. Doting, smothering, ignoring personal boundaries, treating someone as an extension or a wish-fulfillment machine, spoiling, emotional blackmail, an ambience of paranoia or intimidation ("gaslighting") - have as long lasting effects as the "classic" varieties of abuse. Mental health disorders - and especially personality disorders - are not divorced from the twin contexts of culture and society. Disparate scholars and thinkers - Christopher Lasch on the one hand and Theodore Millon on the other hand - have concluded as much. Narcissistic behaviors - now labeled "misconduct" - have long been nornmative. The basically narcissistic traits of individualism competitiveness, unbridled ambition - are the founding stones of certain versions of capitalism. Thus, certain forms of abuse and bullying actually constitute an integral part of the folklore of corporateAmerica. As long as this is the case, workplace abuse would be hard to overcome. Vaknin, for being our guest this evening and for sharing this information with us. And to those in the audience, thank you for coming and participating.

In a controlled second-line therapy trial of Metaglip 5 mg/500 mg perindopril 4mg free shipping, the numbers of patients with hypoglycemia documented by symptoms and a fingerstick blood glucose measurement ?-T50 mg/dL were 0 (0%) for glipizide order perindopril 8mg online, 1 (1 purchase perindopril 8mg otc. Gastrointestinal symptoms of diarrhea, nausea/vomiting, and abdominal pain were comparable among Metaglip, glipizide and metformin in the second-line therapy trial. Overdosage of sulfonylureas, including glipizide, can produce hypoglycemia. Mild hypoglycemic symptoms, without loss of consciousness or neurological findings, should be treated aggressively with oral glucose and adjustments in drug dosage and/or meal patterns. Close monitoring should continue until the physician is assured that the patient is out of danger. Severe hypoglycemic reactions with coma, seizure, or other neurological impairment occur infrequently, but constitute medical emergencies requiring immediate hospitalization. If hypoglycemic coma is diagnosed or suspected, the patient should be given a rapid intravenous injection of concentrated (50%) glucose solution. This should be followed by a continuous infusion of a more dilute (10%) glucose solution at a rate that will maintain the blood glucose at a level above 100 mg/dL. Patients should be closely monitored for a minimum of 24 to 48 hours, since hypoglycemia may recur after apparent clinical recovery. Clearance of glipizide from plasma would be prolonged in persons with liver disease. Because of the extensive protein binding of glipizide, dialysis is unlikely to be of benefit. Overdose of metformin hydrochloride has occurred, including ingestion of amounts >50 g. Hypoglycemia was reported in approximately 10% of cases, but no causal association with metformin hydrochloride has been established. Lactic acidosis has been reported in approximately 32% of metformin overdose cases (see WARNINGS ). Metformin is dialyzable with a clearance of up to 170 mL/min under good hemodynamic conditions. Therefore, hemodialysis may be useful for removal of accumulated drug from patients in whom metformin overdosage is suspected. Dosage of Metaglip must be individualized on the basis of both effectiveness and tolerance while not exceeding the maximum recommended daily dose of 20 mg glipizide/2000 mg metformin. Metaglip should be given with meals and should be initiated at a low dose, with gradual dose escalation as described below, in order to avoid hypoglycemia (largely due to glipizide), reduce GI side effects (largely due to metformin), and permit determination of the minimum effective dose for adequate control of blood glucose for the individual patient. With initial treatment and during dose titration, appropriate blood glucose monitoring should be used to determine the therapeutic response to Metaglip and to identify the minimum effective dose for the patient. Thereafter, HbAshould be measured at intervals of approximately 3 months to assess the effectiveness of therapy. The therapeutic goal in all patients with type 2 diabetes is to decrease FPG, PPG, and HbAto normal or as near normal as possible. Ideally, the response to therapy should be evaluated using HbA, which is a better indicator of long-term glycemic control than FPG alone. No studies have been performed specifically examining the safety and efficacy of switching to Metaglip therapy in patients taking concomitant glipizide (or other sulfonylurea) plus metformin. Changes in glycemic control may occur in such patients, with either hyperglycemia or hypoglycemia possible. Any change in therapy of type 2 diabetes should be undertaken with care and appropriate monitoring. For patients with type 2 diabetes whose hyperglycemia cannot be satisfactorily managed with diet and exercise alone, the recommended starting dose of Metaglip is 2. For patients whose FPG is 280 mg/dL to 320 mg/dL a starting dose of Metaglip 2. The efficacy of Metaglip in patients whose FPG exceeds 320 mg/dL has not been established. Dosage increases to achieve adequate glycemic control should be made in increments of 1 tablet per day every 2 weeks up to maximum of 10 mg/1000 mg or 10 mg/2000 mg Metaglip per day given in divided doses. In clinical trials of Metaglip as initial therapy, there was no experience with total daily doses >10 mg/2000 mg per day. For patients not adequately controlled on either glipizide (or another sulfonylurea) or metformin alone, the recommended starting dose of Metaglip is 2. In order to avoid hypoglycemia, the starting dose of Metaglip should not exceed the daily doses of glipizide or metformin already being taken. The daily dose should be titrated in increments of no more than 5 mg/500 mg up to the minimum effective dose to achieve adequate control of blood glucose or to a maximum dose of 20 mg/2000 mg per day. Patients previously treated with combination therapy of glipizide (or another sulfonylurea) plus metformin may be switched to Metaglip 2. The decision to switch to the nearest equivalent dose or to titrate should be based on clinical judgment.

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That will hurt them and you more than a hidden video perindopril 8 mg low price. David: I also want to touch on school issues tonight buy cheap perindopril 4mg on line. One of the toughest problems some parents have is getting the school to work with them generic 8mg perindopril mastercard. George Lynn: As always, a good evaluation is very important. The specific educational deficiencies that a child has must be documented, and many kids with Bipolar Disorder challenges have ADD-like learning issues. Number two is getting across the idea that schools destabilize our kids and that unique structures have to be put in place to insure stability on a day-to-day basis. Doing this will require a write-up from your psychiatrist. Finally, you face all the issues people do with NB involved kids. See chapter 15 of my first book for hard-learned lessons of ways to deal with the bureaucratic part. It discusses dealing with the school system and getting what your child deserves and is entitled to. I encourage you to drop by and read through her site. Mell: I can understand this zero tolerance policy schools have, but if a 6 year old threatens to blow up the school, why would they take it seriously? George Lynn: IMHO schools are trying to deal with overcrowding by using methods that lose sight of the situation of individual children. You require the school to continue to educate him until they are satisfied that he can return to class. The important thing is to know that you do have rights in the situation. Oftentimes, we take it for granted that the system can get away with this kind of "Spartacus like" treatment of our kids, but we all have rights. David: Some comments on how schools react to threatening behavior: C. Gates: Yes, they do take it seriously here in Houston, Texas. CABF has very informative handouts from their site to use. I did this and it really helped the teachers to better understand why my son does some of the things he does. Kris23: Do you find that many Bipolar kids are also gifted? They most often show gifts as (believe it or not) little philosophers or writers. Learning disabilities often involve short-term memory issues and all the ones caused by impulsivity. When I am working with these gifted kids, I try to give them a story line about themselves and confidence that things will work out. Fact is the research is positive for bipolar children who get medical attention. One more thing I have noticed is that the parents of these kids themselves are often outstanding in some area. It seems it is getting more difficult as he gets older. Batty: There is a great book, Uniquely Gifted: Identifying and Meeting the Needs of the Twice-Exceptional Student by Kiesa Kay, that addresses gifted children with learning disabilities!! We are the only ones who can help our children even though it is so difficult for us. I always wonder if I am doing everything I can because the process is so slow. On one hand, raising kids like ours can be bruising. On the other, it really helps to keep a vision of what is possible for your child, and to document his accomplishments and yours. Keep your sense of humor and try to find the central patterns in his personality that are unique. Oftentimes our kids can think deeper and be more creative than "neurotypicals," so holding that vision is very important.

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I am Bipolar and have Obsessive Compulsive Disorder (OCD) order 4mg perindopril with visa. My question is what chance is there that my son will suffer from a mental illness? Severus: It is hard to tell buy perindopril 2mg overnight delivery, but you should remember: Even if the genes are involved in bipolar illness buy generic perindopril 4mg on line, environment also plays an important role. Severus: Sure, there is a new psychotherapeutic approach called: Social rhythm therapy. Severus: Yes, social rhythm therapy focuses on restoring and maintaining personal and social daily routines to stabilize body rhythms (especially the 24 hour sleep-wake cycle). Severus: Well, we think that it translates into increased mood stability. It may also decrease the stimulation threshold, however, this is a hypothesis. Christmas holidays are usually the hardest, but not all the time. Severus: You can try it, but you should start then pretty soon. Another, and maybe better option, might be to invite friends for Christmas, if it is possible. Severus: Are you hypothyroid, or do you have elevated T3/T3 levels? Taking a thyroid supplement might be good option for a "hypothyroid" goiter if you developed it under Lithium. Pjude9: Could you explain why anti-psychotics such as Zyprexa and Seroquel are used in treating bipolar? Severus: If you are suffering from severe depression, than this combination alone is not helpful, you might consider adding the Omega-3s. By the way, I would always recommend a daily mood chart to monitor symptoms and improvement when you change medications. I think that this is extremely helpful, especially also in retrospective. This is why polypharmacy (taking several medications) has become so frequent. You can click on this link, sign up for the mail list at the top of the page, so you can keep up with events like this, please take a look around. She mentioned that when she was first diagnosed, that they gave her some test that pointed to manic depression. Was there ever such a test, and will there ever be a definitive test to prove medically that I suffer from bipolar? Severus: I doubt that this test was reliable, and I am a bit skeptical whether we will have such a test in the near future. However, we can diagnose bipolar disorder even without a "test" pretty well. PSCOUT: Can you please discuss the use of Neurontin as a mood stabilizer? Severus: Gabapentin seems to be especially helpful in the treatment of anxiety in bipolar disorder. Furthermore, I am not aware of any well-controlled data regarding long-term mood-stabilizing properties. David: Just to make sure, Gabapentin and Neurontin are one and same, correct? SaxDragon78412: I have read some reports that people with bipolar should not take Melatonin supplements, and other reports that we should. Severus: Melatonin might be helpful to improve sleep during a depressive episode, but it does not have anti-depressive properties. It might also be useful to treat jetlag, which is especially dangerous for people suffering from bipolar disorder. However, even on the medications, I still have some mood fluctuations. What besides medications and omega 3, can I do to try to keep my moods stable? Severus: Here are some suggestions for maintaining mood stability:Exercise on a regular basis. Some people also report that white sugar makes them feel worse. Start some kind of relaxation technique (Diaphragmatic breathing for example seems to be helpful for some). Try to reduce stress at work and during your leisure time!

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